00070155 CITY OF CUPERTINO -
Hmt.mNc utvtstoN PERMIT CONTRACTOR INFORMATION:
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BUILDING ADDRESS: 'V ' ? - -
�WKER'S NAM@. APPI ATION SUBDATE. `
2075E CHERYL''DR BRYAN KNAPP•,PLUMBING 00070].5_5
SANITARY NO. CONTROL N'O, -
F'AULSON . ROBERT aH '.TRIJSTEE 301.8 'BREEN CT . . 07/25/2000
Q O.O ARCHITECTIENGINLIN - • ', . j BUILDING PERMIT INFO - -
408,1,E29-7E78 BLDG s IT PLUME MUCH
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LICENSED hatI CONTRACTOR'S Visions oATION - _ rd.� ]OI7 DOSCI'1 tlOn - '
zg4' Ihemby af(Irm lh tl le :d d p fCNpmr9(cum,c ng y p•
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I n3 ofine Bl. dP C '.v,onx Calc and rayl », i� 9 d' -
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ARCHITECT S DECLARAI R f
1 drstandm,plans shall be used :Iamtrayn� a _ RF_.—PIPE
OWNER BUILDER DECLARATION
I hereby a ff that 1 m r theContractor',L Lo for the ,.
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followingra n (Section IlH1 S B .' d Pro[ itC d Any city county -
- x❑ wh h 9 P t I construct, P o d Ih P y structure rY- °priort t I. 9 to ppl if such pe II II signed.t term
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had lie licensed p I ( p o of the Contractors 1 1 (Chapter 9 ySq:Ft. Floor Area Valuation '
-I'oun enc ny with Seel on 70o))of Diemen n l ohne H,.tiac:and P fe,F ens Code) - '
or Inas he is exempt mead ora add the bast,for the alleged exemin ion.Any violation -
ofsen'orun 70i15byany appl ttt tape 1. bi ..the upplcanm,civil'entry .
if,a rasa man rive n,cared dollars rsslxp >,` y 1 :APN Number _ _!Occupancy Type
❑lLe,ofinepropeny or n,y employ - ichwagesasll le ct npeastaitn' A L.• _ - -♦$0•.
will 11 bstripe:I I e'. Iintended diluted far le(See 70,14"
0,14 Required Ins eCtlOtls `
Bo. - dP f Code The C tach, Lice,u La do,, It Iplyt t , - .�' q - p f -
nwn Ip own¢employees.
p . at q n d -ran kn 'If 35916.016.s 00
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or far sa nilly provided or r h p t: Iintended - 't - .
de rm for sale If,Interest,fir mel havbuilding nprme,rot's...Id with t nue year or a
dent Inc awand-builder' will have me hu,, of prong that h I'd m,l mild or - r ' •' '
imp,nve for pari,nse nl:ln). _ , , 202 UNDERFLOOR ' PLUMBING `.. '.
UI t ftheproperty, exclusively contracting within do i' I'.t • rr ,301,t"-'— 'ROUGH -PLUMBING
construct theproject(S 70,14 B d Professions Cid I Th C t cI - ti. r::`• ,..,
uo L dpplyt fp pdy n tr 11 mil ,d to ; 502:-r FINAL PLUMBING ENERGY
co Ibt .contracts' ^projects cash n mrcm 1 : 1 n :ant m 50T FINAL 'PLI_IMB I NG :Y,
- U exempt under Sec. It&P 6for Ihis mason .'.£ t .
t . - - -
Date
Owner wORKER'S COMPENSATION DF,CI:AItATION. - n �
I hereby arfinn hash,d -Penalty of p j ry •of the following declarations
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I Neve and will Ina dta n a Certificate of Ourvsem.to sell-insure foi,svorker's -
Compens arka its pr J 1 f- by Seddon 1700 I"the Labor Cede for the T -
pert a of the sonk for which thus p nr I s .sued. -
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17M dwb ran t ' or k C,mpe al I c - dby5 I u
b7 W d Inc eke,GOdC f m performance f c, 'k i which the per tit's• 't „
slued My We keraQ npunsnf Inst 'crmd Pnlieynbmberarc., •y � e ,
Chi - ' •.Policy Nti tt
•', - CER'I'IFICAI'ION OF EXEMPTION FROM WORKERS' k.
COMPENSATION INSURANCE ,x - - -
(I'll section, d t heu,mpleid if ane permit is f - headredJlla. rI ,
locr ify Inn in thep oofthework firwhich d p his issued,) - - •'W r' .. _
.shall not c,ploy a,l p r b c b] I I d Workers v v
Compensnuon f D -
pill Dant ��{y{�
ICET�I1 rl 'An,71i III t-T F npl y :h old
_ � 0bee tJ u ❑ W k C P n t p n. ,f th LM Cal y, cast 't , ,.
tfnnl 'tl comply with I pnl: n xd' Iermil shall neJ mrd rvvokeA ;� 2F _ -i
F,y IXINSI RUCTION LLNDIN alta,r CY
I hereby fr m that Per l c u b m t 097,Co,ene}f r the p_rfonn .'"•
w •ol'n kfor w_h'chm Permit is ucl(Sc 1097 C' .O7
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Let Wer blood
r7z Le ler:Address
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V 0 1 study that l base d dapplicationa l tar thin theI bound
k' Ful'
correct.1 g t ply d II q had my d' and o t'I :,alai tab -
_-0 r) mM1 ld lg t t dh hYamh tae pe,enmt cs of m, city to til
r� the h emenusnedp iolyf :p t p p f
(W) g t . lenmlry dkeep farni W City fCupertino_ b st a '
In linblle: J Jgme a. t d pe es which y any }diose ubam laid
Ca i� City n sequence(if the granting of this rental. r ' t - (^11 •
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT ISSUed.b 1 -� DBIe l
�• OURCE TIONS - ,,''�.p y'
. Signaman p dint n.emr '"- c .Re—roofs.
y HAZARDOUS MAI CRIALS DISCI OSl1RL
will the applicant future building p t t or historic h 1 a nater el Type Of Roof
as dented by the Casett e.Mt sic pal Cafe,Chapter 9.12,a id the Healln and Safety
Code. O Yes 25532(Nf -. ❑No � .-� T�
r• - l .r All•roofs shall be inspected prior to any roofing material being installed.
W m pili' I rt n l ri d >c e B .,Pall i e_n device,' i e IP a roof is installed without first obtaining'an inspection, I agree Co remove '
mlh' aN c'air cnnNn Doors as deleted by he Bey ArenA Quality M,m Bement r 1 '
oar oyes UNo all new materials for'inspection. Applicant understandsand will comply with
^-' all non-point source regulations.
1 base mrd(he h d :inalcoul,occuncered, dcr Chapter(.)5 or h s
TCalif n Health, Safety 0 d Seen,,.,25505 it
125534understoodftl t - * 't. e d •,
'llhch lid' b l t tlyh I I that l . y p Ruddy of tate
• nwupam tar the requ'r is xfimM1 nmsl b I prior m Ira once t f a Ceh Oc le of r �
I
°acopaa`y, - I ' Signature of Applicant.,• Date'
Owner.en ann,nnam agem- Date s All roof,coverings,to be Class"B" or better;:.
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